To qualify for NY Medicaid long-term care, your parent needs to be medically eligible (need help with daily activities, demonstrated through a UAS-NY assessment by an MLTC plan), income-eligible, and asset-eligible. The medical piece is functional, not diagnostic. The financial pieces are where New York’s distinctive structure shows up.

The dual-track look-back — what makes NY unique

New York is the only state with two different Medicaid look-backperiods depending on the setting of care.1

For nursing-home Medicaid (institutional), the look-back is the federal standard: 60 months from the month of application. NY reviews every transfer for less than fair market value during that window. Penalty math: the value of the transfer divided by the regional penalty divisor, which ranges from about $11,724 in Western NY to $14,449 on Long Island in 2025.2A $200,000 gift in 2023 with a 2026 application in NYC (divisor $14,012) produces ~14.3 months of penalty — Medicaid won’t pay even though your parent is otherwise eligible.

For community-based Medicaid (home care, MLTC, Assisted Living Program, NHTD, TBI waivers), the look-back is statutorily 30 months, but has not yet been enforcedas of this writing. The statutory authority traces to the NY 2020–21 budget, Part MM, codified at SSL §366(5)(e). Implementation has been delayed by COVID-era federal continuous-coverage rules, lack of full CMS approval, and operational complexity at LDSS/HRA. NYSDOH retains authority to begin enforcing with adequate public notice.

Spousal protections — and “spousal refusal”

For one-spouse-needs-care couples, NY follows federal community- spouse protections at the top of the federal range. The community spouse keeps the MMMNA ($3,948/month in 2025) and theCSRA(up to $157,920 in 2025). The community spouse’s income belongs to the community spouse; only the institutionalized spouse’s income is counted for the institutionalized spouse’s eligibility.3

Additionally — and this is a major NY-specific planning tool — NY recognizes spousal refusal under SSL §366(3)(a). A community spouse may formally refuse to make assets or income available to the institutionalized spouse. Medicaid is required to cover the institutionalized spouse regardless. The state may later seek a contribution from the refusing spouse, but the institutionalized spouse receives coverage in the interim.4

Spousal refusal is rare among the states and is a powerful (and controversial) NY-specific option. The refusal letter must be drafted carefully; the state’s claim against the refusing spouse can be substantial; the calculus depends on the spouses’ relative life expectancies and asset profile. A NY-admitted elder-law attorney is essential.

Excess Income / spend-down, in plain English

In states that use Qualified Income Trusts (Florida, Texas, others), a parent with income above the Medicaid limit routes the excess into a trust each month; the trust pays the facility; the income no longer counts. New York does not do this.5 Instead, NY uses a monthly spend-down:

  1. Apply for Medicaid as normal.
  2. State calculates excess income (income above $1,800/month for a single 65+ adult in community Medicaid, 2025).
  3. Each month, the recipient either pays in the excess to LDSS/HRA, pays providers directly, or incurs unpaid medical bills equal to the excess.
  4. Once the spend-down threshold is met, Medicaid covers the rest of the month.

Alternatively, the recipient may direct excess income into a pooled-income trustadministered by a NY nonprofit (NYSARC, Center for Disability Rights, Disabled and Alone). The trust pays the recipient’s living expenses (rent, utilities, food) and the income no longer counts. This is structurally analogous to a QIT but is governed by a different federal subsection — 42 USC §1396p(d)(4)(C) — and is administered by a nonprofit, not by family.6

Managed Long-Term Care — mandatory in most counties

If your parent qualifies for Medicaid and needs more than 120 days of community long-term care, in most NY counties they must enroll in a Managed Long-Term Care (MLTC) plan.7Enrollment runs through NY Medicaid Choice, the state’s contracted enrollment broker, which provides plan options. Your parent selects a plan (or one is auto-assigned), the plan conducts a UAS-NY assessment to determine personal-care hours per week, and the plan then contracts with one or more home- care agencies or, under CDPAP, with a fiscal intermediary that lets the recipient employ their own aides — including family members in most cases.8

Plan choice matters more than families realize. Two plans operating in the same county can apply the UAS-NY assessment differently and produce different hour authorizations. Plans differ in CDPAP responsiveness, spend-down accommodation, and contracted-agency network. Use the NY Medicaid Choice comparison tool; ask plans for sample hour authorizations for your parent’s diagnostic profile; talk to a NY-admitted elder-care advocate (LCSW or attorney) who works this market.

The five common NY-specific mistakes

What to do this month

For the broader federal Medicaid framework, see our Medicaid pillar overview. For the NY legal and Surrogate’s Court detail that intersects with Medicaid planning, see Legal & Financial in New York. Compared to Florida’s approach, see Florida Medicaid.